Lung ultrasound and supine chest X-ray use in modern adult intensive care

In critically ill patients with acute respiratory failure, thoracic imaging is essential for assessing disease characteristics, extent, and progression, aiding in clinical management decisions. While computed tomography (CT) is considered the gold standard for detailed imaging, its limitations, including transportation challenges and radiation exposure, restrict its widespread use in the ICU. Chest X-rays and lung ultrasound (LUS) have emerged as valuable alternatives, with LUS gaining prominence due to its real-time applicability at the bedside. LUS allows dynamic assessments, such as monitoring lung sliding, enabling swift adjustments in mechanical ventilation and therapeutic interventions, which can improve patient outcomes. Its utility expanded during the COVID-19 pandemic, further solidifying its role in intensive care settings.

This review explores the evolution of lung ultrasound (LUS) and the decreasing reliance on chest X-rays in ICUs over the past three decades, highlighting significant advancements in imaging technology. LUS has proven instrumental in enhancing patient safety, offering rapid bedside diagnostics, and supporting ongoing monitoring. Moreover, economic benefits and reduced radiation exposure favor LUS over routine chest X-rays. However, key challenges include the need for skilled operators, standardized image acquisition methods, and uniform reporting protocols. Future advancements in LUS technology could allow for real-time bedside image review and continuous monitoring, further integrating it into ICU practices.

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